ストーマ閉鎖術における環状皮膚縫合法の有用性の検討 [in Japanese] Complications after Stoma Closure : Comparison between Circumferential Subcuticular Wound Approximation and Conventional Simple Skin Suture [in Japanese]
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目的 : ストーマ閉鎖術は合併症発生率が20～40%と高く, ほとんどが創部感染である. ストーマ閉鎖術において創部を巾着状に縫縮する環状皮膚縫合法の有用性に関してretrospectiveに検討した. 方法 : 当施設で経験したストーマ閉鎖術66例を, 単純皮膚縫合施行群 (単純縫合群) 33例と環状皮膚縫合施行群 (環状縫合群) 33例に分けて臨床背景, 早期合併症, 術後在院日数に関して検討した. 結果 : 両群間で臨床背景に有意差はなかった. 創部感染率は環状縫合群で有意に低かった (環状縫合群0%対単純縫合群27%, p=0.002). 全合併症発生率も環状縫合群で有意に低かった (9%対36%, p=0.017). 術後在院日数も環状縫合群で有意に短かった. また術後瘢痕は5～20mm大の点状瘢痕であり整容性でも優れていた. 結語 : 環状縫合法は創部感染の減少と創部瘢痕の整容性から極めて優れた術式であると考えられた.
The aim of this study was to assess the usefulness of circumferential subcuticular wound approximation (CSWA) for skin suture in stoma closure.<br>The subjects were 66 patients who underwent a stoma closure at our institution, and were divided into two groups : simple suture group (SG) of 33 patients undergoing conventional simple skin suture ; and CSWA group (CG) of 33 undergoing CSWA. The two groups were retrospectively compared regarding their clinical characteristics, early postoperative complications and postoperative hospital stay.<br>There was no significant difference between the two groups regarding their clinical characteristics. The wound infection rate was significantly lower in the CG (0%) than the SG (27%) (p=0.002), as was the overall complication rate (CG 9% vs. SG 36%, p=0.017). Concerning the other complications, no difference was found between the two groups. The hospital stay was significantly shorter in the CG (mean 16 days) than the SG (22 days), although this might have been influenced by the recent tendency to reduce the hospital stay. The postoperative skin scar after CSWA was usually a tiny round scar of 5 to 20mm in diameter, which was cosmetically superior to a liner scar of 70 to 80mm in length after conventional simple skin closure.
- The Japanese journal of proctology
The Japanese journal of proctology 60(2), 55-60, 2007-02-10
The Japan Society of Coloproctology